Using your belly and pelvic floor muscles to help bring about a bowel movement is instinctive for most people. However, people sometimes have problems with these muscles and must relearn proper emptying techniques. If you discover weaknesses in your muscles, continuously ignore and fight the urge to go to the bathroom, or consume a diet low in fiber and water, you may be straining to conduct a bowel movement. You may be doing this if you:

• Hold your breath or take in a gulp of air and hold it.
• Keep your lips and jaw tensed and closed tightly.
• Turn red in the face because of excessive pushing or forcing.
• Develop hemorrhoids or have existing hemorrhoids worsen.
• Get faint while pushing.
• Aren’t emptying, resulting in many trips to the restroom to feel complete.

Straining makes it harder to conduct a bowel movement. In some cases, the anus can tighten instead of relaxing and opening, resulting in difficulty getting stool out. Here’s how to sit on the toilet to relieve constipation.

EVACUATION PLAN: Conducted in 4 Basic Steps

When conducting a bowel movement, it is essential to position yourself appropriately.

1. Lean forward enough for your elbows to rest on your knees. Keep your back straight and avoid slouching.
2. Support your feet on the floor or use a low stool if your feet don’t touch the ground.
3. Push out your belly as if you have swallowed a beach ball. You should feel a widening in your waist.
4. Exhale and keep your stomach out.

Proper Bowel Elimination

Your healthcare practitioner may make the following additional suggestions and adjustments:

• Sit on the toilet.
  • Make sure your feet are supported.
  • Notice your hip angle and spine position – most people lean forward or raise their knees, which can help the muscles surrounding the anus to relax.
  • when you lean forward, place your forearms on your thighs for support.
  • With proper positioning, the pelvic floor muscles relax, and the bowel angle decreases, allowing ease of elimination.
• Relax.
  • The digestive tract starts at the mouth and ends at the anal opening, so be sure to relax both ends of the tube.
  • Breathe deeply in through your nose and out slowly through your mouth.
  • Keep your pelvic floor muscles relaxed; let your belly bulge out.
• Empty.
  • Inhale and stick your belly out as if you swallowed a beach ball.
  • Exhale, keep your belly out and make it hard; this widens the anal opening.
• Complete.
  • After completing your bowel movement, you can consider performing one or two pelvic floor muscle contractions.

Consider these steps when you sit on the toilet to relieve constipation. If you don’t feel any progress after conducting these steps, consult a health practitioner about the next steps in the process. Visit our Pelvic Health Page for more information about how physical therapy can help.

Written by Life Fitness Physical Therapy, with multiple locations throughout the Baltimore Area.

What is pelvic organ prolapse?

Pelvic organ prolapse, categorized as a pelvic floor disorder, affects almost 3% of women in the U.S. The pelvic floor is a group of muscles that form a hammock across the patient’s pelvic opening. These muscles and the tissues surrounding them keep the pelvic organ in place. These organs include the bladder, uterus and cervix, vagina, small bowel, and rectum. These muscles and tissues can develop problems or disorders and become more common as women age.

What is a prolapse?

Prolapse can happen when the pelvis muscles and tissues can no longer support these organs because they are weak or damaged and can cause one or more pelvic organs to drop or press into or out of the vagina.

What causes pelvic organ prolapse?

Pelvic organ prolapse is when the muscles and ligaments supporting a patient’s pelvic organs weaken, and the pelvic organs can drop lower into the pelvis, creating a bulge in the vagina (prolapse). Pelvic organ prolapse most commonly develops years after childbirth, a hysterectomy, or menopause.

Patients may experience pelvic pain for a variety of reasons. These reasons could include:

• Myofascial (muscle & fascia): Muscles of the pelvic floor can be tense, weak, shortened, or uncoordinated. Scars and fascia tightness may contribute to pain.
• Organ-related: The origin of the pain is primarily from an organ: the vulva, bladder, bowels, or uterus; Common medical diagnoses include vulvodynia, interstitial cystitis, painful bladder syndrome, endometriosis, irritable bowel syndrome, or menstrual pain.
• Nerve-related: Pudendal neuralgia is often referred to as “the carpel tunnel syndrome of the pelvic floor”. This condition is brought forth by the pudendal nerve compressing and can cause perineal or rectal pain. Injuries during childbirth, prolonged downward pressure on the pelvic floor, prolonged sitting, and bicycling are common causes of pudendal neuralgia.

What are the symptoms of a pelvic organ prolapse?

• Feeling of pressure, discomfort, aching, or fullness in the pelvis.
• Pelvic pressure that worsens with standing or coughing as the day continues.
• Trouble controlling bowels or urine, leading to leaks.
• Uncomfortable pressure during physical activity.

*Symptoms could worsen at certain times of the day, during physical activity, or after standing for a long time.

Physical Therapy for Pelvic Organ Prolapse

Pelvic Floor Physical Therapy is one of the most common treatments for pelvic organ prolapse. This specialized physical therapy relieves the symptoms of pelvic floor dysfunction and strives to help the patient’s muscles work how they should.

Pelvic floor therapy typically includes several exercises and helps the muscles relax and gain strength. A pelvic health physical therapist will work with the patient to see how strong their core muscles are and how much endurance their body has while checking the coordination of their pelvic floor muscles.

This initial assessment will help develop a plan exclusively for the patient’s body. Pelvic floor therapy plans commonly include both external and internal therapy.

Dry Needling Trigger point therapy

Trigger point dry needling is a safe, effective, and efficient treatment technique to release pain from taut bands of skeletal muscle. Trigger point dry needling uses small, thin needles to stimulate underlying myofascial trigger points, muscular and connective tissues for the management of many orthopedic conditions, both acute and chronic. By inserting a needle into the dysfunctional tissue, it often leads to a contraction of the muscle which then stimulates a release. This leads to a reduction of pain, improvements in flexibility, and restoration of normalized movement when combined with corrective exercises.

Kegels

Kegels are known for strengthening the pelvic floor as well. This exercise can help the pelvic floor muscles by contracting and relaxing them. Pelvic floor exercises such as Kegels are personalized exclusively for each patient. These personalized routines include the number of repetitions, variety of positions, time holding a pose, time relaxing, and coordination with breathing and other key muscle groups. Talk to a pelvic health physical therapist about conducting this exercise and adding it to your personalized plan.

Electrical Stimulation (ESTIM)

Pelvic health physical therapists may include ESTIM as part of treatment.  Electrical stimulation works by inserting a small probe into the vagina and sending mild electrical impulses to stimulate the muscles in your pelvic floor. Electrical Stimulation can help reduce pain and muscle spasms in the pelvic region.

Biofeedback

Biofeedback, like electrical stimulation, uses a device to check the contraction of the pelvic floor muscles. It works by placing electrodes on the outside of the body or using internal probes to measure the tension and relaxation of the pelvic floor muscles. Pelvic health physical therapists use biofeedback to help guide patients as they work to strengthen or relax pelvic floor muscles.

Pelvic floor physical therapy can help reduce and eliminate symptoms of pelvic organ prolapse. Research supports using pelvic floor muscle training as an effective treatment option for patients with Grade 1 or Grade 2 pelvic organ prolapse. Once an individual’s prolapse exceeds Grade 2, they may still be able to proceed with pelvic floor therapy, but surgery is the recommended treatment for Grade 3 and Grade 4 pelvic organ prolapse.

If you find yourself in need of a pelvic health physical therapist, talk to your Ob/Gyn about what options are right for you.